Comparação da fase preparação do triplo hop test em mulheres com e sem síndrome da dor femoropatelar: análise cinemática, cinética e eletromiográfica

Abstract

The asymmetry in the lower limbs alignment during weight-bearing activities are related with patellofemoral pain syndrome (PFPS), due to an increase on the patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during preparation phase of the single leg triple hop test (SLTHT) that may influence the biomechanical behavior. The objective of this case-control study was to compare the trunk and lower limb kinematic, kinetic and muscles activities during the preparation of the SLTHT in women with PFPS to pain free controls. Trunk, pelvis, hip, knee, ankle kinematics, hip, knee, ankle kinetics and gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL) muscle activation were recorded from twenty women with PFPS and 20 controls during the preparation of the SLTHT. Between group differences were calculated using three separate multivariate analysis of variance for kinematics, kinetics, and electromyographics data. Women with PFPS showed ipsilateral trunk lean (mean difference [MD]=12°; effect size [ES]=2,6), greater trunk flexion (MD=5.4°; ES=1.3), contralateral pelvic drop (MD=7.5°; ES=2.7), hip adduction (MD=6.2°; ES=1.7) and internal rotation (MD=8.6°; ES=1.9), and ankle pronation (MD=10.4°; ES=1.7); greater internal hip abductor (MD=0.6 Nm/Kg ; ES=1.7) and ankle supinator (MD=0.3 Nm/Kg; ES=1.2) moment and lower internal hip (MD=2.0 Nm/Kg; ES=2.1), knee (MD=0.3 Nm/Kg; ES=0.9) and ankle (MD=0.4 Nm/Kg; ES=0.7) extensor moments; greater GM (MD=10.2%; ES=1.0), GMed (MD=10.4% ; ES=1.0), BF (MD=7.4%; ES=0.7) e VL (MD=28.9%; ES=2.0) muscle activities. In conclusion, ipsilateral trunk lean, excessive contralateral pelvic drop, hip adduction and internal rotation are related to abnormal movement pattern in women with PFPS. The increased trunk flexion, internal hip abductor moment, internal ankle supinator moment and greater GM and GMed EMG activity seem to be control strategies for a deficient dynamic alignment of the lower limb and trunk.